What is sphincter of Oddi dysfunction?
The sphincter of Oddi is a round muscular sphincter that controls the common opening between the bile ducts and the pancreatic ducts into the small intestines. It opens and allows bile and pancreatic juice to flow through and then squeezes shut. When it doesn’t open as it should or is blocked, it’s called sphincter of Oddi dysfunction. This leads to a backup of digestive juices and bile that can cause severe abdominal pain similar to gallstones.
We don’t know exactly what causes this condition, but it tends to affect young women the most. Other risk factors may include having a history of weight loss surgery (gastric bypass surgery), surgery to remove the gallbladder (cholecystectomy), pancreatitis, or gallstones. If you have abdominal pain, your healthcare provider may use various imaging tests and blood tests to rule out any life-threatening conditions, like pancreatic cancer. An accurate diagnosis is important for determining the right treatment.
Because this condition is uncommon, it’s important to seek treatment from pancreas experts with experience managing the disease and its potential complications, such as pancreatitis and chronic pain. At MedStar Health, our gastroenterologists work closely with surgeons and other specialists through our Pancreas and Liver Diseases Program to provide comprehensive, personalized care for patients with a dysfunctional sphincter of Oddi.
Sphincter of Oddi dysfunction symptoms
The most common symptom is severe abdominal pain in your upper right side. This pain can be debilitating, lasting for minutes to hours. Other sphincter of Oddi dysfunction symptoms may include:
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Stomach pain that can feel similar to a gallstone attack or ulcer
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Jaundice (yellow discoloration of your skin or the whites of your eyes) caused by bile backing up into the liver
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Nausea and vomiting
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Attacks of pancreatitis (inflammation in the pancreas)
If you have repeated bouts of severe stomach pain, you should call a healthcare provider. You should also seek medical care if you experience fever or chills, especially after gallbladder or weight loss surgery.
Diagnosis and types of sphincter of Oddi dysfunction
If you have signs of sphincter of Oddi dysfunction, your healthcare provider will ask questions about your medical history and symptoms. Next, they may recommend diagnostic tests that will look for several possible causes of your abdominal pain. This may include tests such as:
- Abdominal ultrasound
- Blood tests that check for abnormal liver or pancreatic enzymes
- Computed tomography (CT) scans
- Endoscopic ultrasound (EUS)
- Upper endoscopy
- Magnetic resonance cholangiopancreatography (MRI/MRCP)
As of recent, sphincter of Oddi disease has been classified into two types:
- Type I dysfunction shows elevated liver enzymes with a dilated bile duct, along with pain
- Type II dysfunction has elevated liver enzymes OR a dilated bile duct, along with pain
Treatment
Treatment will vary based on your symptoms and the category of your disease. Sphincter of Oddi dysfunction treatment may involve:
- ERCP with sphincterotomy, a surgical procedure to cut the sphincter to allow for drainage or removal of any blockages. Surgery is typically reserved for patients with severe pain and category I or II dysfunction. ERCP with sphincterotomy is effective approximately 50 percent of the time. Learn more.
- Medications, including calcium channel blockers, certain antidepressants, and other prescriptions that may help to relax the sphincter.
